Healthcare Provider Details

I. General information

NPI: 1497924195
Provider Name (Legal Business Name): ELLEN D SPANDORFER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LAKE HEARN DR NE STE 275
SANDY SPRINGS GA
30319-1411
US

IV. Provider business mailing address

1200 LAKE HEARN DR NE STE 275
SANDY SPRINGS GA
30319-1411
US

V. Phone/Fax

Practice location:
  • Phone: 770-299-3636
  • Fax:
Mailing address:
  • Phone: 770-299-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY003147
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: